CHAPTER What Is Morality? - Ethics

[Pages:13]1 CHAPTER

What Is Morality?

We are discussing no small matter, but how we ought to live.

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, P ' REPUBLIC (ca. 390 . .)

1.1. The Problem of Definition

Moral philosophy is the study of what morality is and what it requires of us. As Socrates said, it's about "how we ought to live"--and why. It would be helpful if we could begin with a simple, uncontroversial definition of what morality is, but that turns out to be impossible. There are many rival theories, each expounding a different conception of what it means to live morally, and any definition that goes beyond Socrates's simple formulation is bound to offend at least one of them.

This should make us cautious, but it need not paralyze us. In this chapter, I will describe the "minimum conception" of morality. As the name suggests, the minimum conception is a core that every moral theory should accept, at least as a starting point. First, however, we will examine some moral controversies having to do with handicapped children. Our discussion will bring out the features of the minimum conception.

1.2. First Example: Baby Theresa

Theresa Ann Campo Pearson, an infant known to the public as "Baby Theresa," was born in Florida in 1992. Baby Theresa had anencephaly, one of the worst genetic disorders. Anencephalic infants are sometimes referred to as "babies without brains," but that is not quite accurate. Important parts of the brain-- the cerebrum and cerebellum--are missing, as is the top of the skull. The brain stem, however, is still there, and so the baby can still breathe and possess a heartbeat. In the United States,

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most cases of anencephaly are detected during pregnancy, and the fetuses are usually aborted. Of those not aborted, half are stillborn. About 350 are born alive each year, and they usually die within days.

Baby Theresa's story is remarkable only because her parents made an unusual request. Knowing that their baby would die soon and could never be conscious, Theresa's parents volunteered her organs for immediate transplant. They thought her kidneys, liver, heart, lungs, and eyes should go to other children who could benefit from them. Her physicians agreed. Thousands of infants need transplants each year, and there are never enough organs available. But Theresa's organs were not taken, because Florida law forbids the removal of organs until the donor is dead. By the time Baby Theresa died, nine days later, it was too late--her organs had deteriorated too much to be harvested and transplanted.

Baby Theresa's case was widely debated. Should she have been killed so that her organs could have been used to save other children? A number of professional "ethicists"--people employed by universities, hospitals, and law schools, who get paid to think about such things--were asked by the press to comment. Most of them disagreed with the parents and physicians. Instead, they appealed to time-honored philosophical principles to oppose taking the organs. "It just seems too horrifying to use people as means to other people's ends," said one such expert. Another explained: "It's unethical to kill person A to save person B." And a third added: "What the parents are really asking for is, Kill this dying baby so that its organs may be used for someone else. Well, that's really a horrendous proposition."

Is it horrendous? Opinions were divided. These ethicists thought so, while the parents and doctors did not. But we are interested in more than what people happen to think. We want to know what's true. Were the parents right or wrong to volunteer their baby's organs for transplant? To answer this question, we have to ask what reasons, or arguments, can be given on each side. What can be said to justify the parents' request or to justify opposing their request?

The Benefits Argument. The parents believed that Theresa's organs were doing her no good, because she was not conscious

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and would die soon anyway. The other children, however, could benefit from them. Thus, the parents seem to have reasoned: If we can benefit someone without harming anyone else, we ought to do so. Transplanting the organs would benefit the other children without harming Baby Theresa. Therefore, we ought to transplant the organs.

Is this correct? Not every argument is sound. In addition to knowing what arguments can be given for a view, we also want to know whether those arguments are any good. Generally speaking, an argument is sound if its assumptions are true and the conclusion follows logically from them. In this case, we might wonder about the assertion that Theresa wouldn't be harmed. After all, she would die, and isn't being alive better than being dead? But on reflection, it seems clear that, in these tragic circumstances, the parents were right. Being alive is a benefit only if it enables you to carry on activities and have thoughts, feelings, and relations with other people--in other words, if it enables you to have a life. Without such things, biological existence has no value. Therefore, even though Theresa might remain alive for a few more days, it would do her no good.

The Benefits Argument, therefore, provides a powerful reason for transplanting the organs. What arguments exist on the other side?

The Argument That We Should Not Use People as Means. The ethicists who opposed the transplants offered two arguments. The first was based on the idea that it is wrong to use people as means to other people's ends. Taking Theresa's organs would be using her to benefit the other children; therefore, it should not be done.

Is this argument sound? The idea that we should not "use" people is obviously appealing, but this is a vague notion that needs to be clarified. What exactly does it mean? "Using people" typically involves violating their autonomy--their ability to decide for themselves how to live their own lives, according to their own desires and values. A person's autonomy may be violated through manipulation, trickery, or deceit. For example, I may pretend to be your friend, when I am only interested in going out with your sister; or I may lie to you so you'll give me money; or I may try to convince you that you will enjoy going to the movies, when I only want you to give me a ride. In each case, I am manipulating you in order to get something for

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myself. Autonomy is also violated when people are forced to do things against their will. This explains why "using people" is wrong; it is wrong because it thwarts people's autonomy.

Taking Baby Theresa's organs, however, could not thwart her autonomy, because she has no autonomy--she cannot make decisions, she has no desires, and she cannot value anything. Would taking her organs be "using her" in any other morally significant sense? We would, of course, be using her organs for someone else's benefit. But we do that every time we perform a transplant. We would also be using her organs without her permission. Would that make it wrong? If we were using them against her wishes, then that would be a reason for objecting--it would violate her autonomy. But Baby Theresa has no wishes.

When people are unable to make decisions for themselves, and others must do it for them, there are two reasonable guidelines that might be adopted. First, we might ask, What would be in their own best interests? If we apply this standard to Baby Theresa, there would be no objection to taking her organs, for, as we have already noted, her interests will not be affected. She is not conscious, and she will die soon no matter what.

The second guideline appeals to the person's own preferences: We might ask, If she could tell us what she wants, what would she say? This sort of thought is useful when we are dealing with people who have preferences (or once had them) but cannot express them--for example, a comatose patient who signed a living will before slipping into the coma. But, sadly, Baby Theresa has no preferences about anything, nor has she ever had any. So we can get no guidance from her, even in our imaginations. The upshot is that we are left to do what we think is best.

The Argument from the Wrongness of Killing. The ethicists also appealed to the principle that it is wrong to kill one person to save another. Taking Theresa's organs would be killing her to save others, they said; so, taking the organs would be wrong.

Is this argument sound? The prohibition against killing is certainly among the most important moral rules. Nevertheless, few people believe it is always wrong to kill--most people think there are exceptions, such as killing in self-defense. The question, then, is whether taking Baby Theresa's organs should be regarded as an exception to the rule. There are many reasons

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to think so: Baby Theresa is not conscious; she will never have a life; she is going to die soon; and taking her organs would help the other babies. Anyone who accepts this will regard the argument as flawed. Usually, it is wrong to kill one person to save another, but not always.

There is another possibility. Perhaps we should regard Baby Theresa as already dead. If this sounds crazy, bear in mind that our conception of death has changed over the years. In 1967, the South African doctor Christiaan Barnard performed the first heart transplant in human beings. This was an exciting development; heart transplants could potentially save many lives. It was not clear, however, whether any lives could be saved in the United States. Back then, American law understood death as occurring when the heart stops beating. But once a heart stops beating, it quickly degrades and becomes unsuitable for transplant. Thus, under American law, it was not clear whether any hearts could be legally harvested for transplant. So, American law changed. We now understand death as occurring, not when the heart stops beating, but when the brain stops functioning: "brain death" is our new end-of-life standard. This solved the problem about transplants, because a brain-dead patient can still have a healthy heart, suitable for transplant.

Anencephalics do not meet the technical requirements for brain death as it is currently defined; but perhaps the definition should be revised to include them. After all, they lack any hope for conscious life, because they have no cerebrum or cerebellum. If the definition of brain death were reformulated to include anencephalics, we would become accustomed to the idea that these unfortunate infants are born dead, and so taking their organs would not involve killing them. The Argument from the Wrongness of Killing would then be moot.

On the whole, then, the arguments in favor of transplanting Baby Theresa's organs seem stronger than the arguments against it.

1.3. Second Example: Jodie and Mary

In August 2000, a young woman from Gozo, an island south of Italy, discovered that she was carrying conjoined twins. Knowing that the health-care facilities on Gozo were inadequate to deal with such a birth, she and her husband went to St. Mary's

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Hospital in Manchester, England. The infants, known as Mary and Jodie, were joined at the lower abdomen. Their spines were fused, and they had one heart and one pair of lungs between them. Jodie, the stronger one, was providing blood for her sister.

No one knows how many sets of conjoined twins are born each year, but the number has been estimated at 200. Most die shortly after birth, but some do well. They grow to adulthood and marry and have children themselves. But the outlook for Mary and Jodie was grim. The doctors said that without intervention the girls would die within six months. The only hope was an operation to separate them. This would save Jodie, but Mary would die immediately.

The parents, who were devout Catholics, refused permission for the operation on the grounds that it would hasten Mary's death. "We believe that nature should take its course," they said. "If it's God's will that both our children should not survive, then so be it." The hospital, hoping to save Jodie, petitioned the courts for permission to perform the operation anyway. The courts agreed, and the operation was performed. As expected, Jodie lived and Mary died.

In thinking about this case, we should distinguish the question of who should make the decision from the question of what the decision should be. You might think, for example, that the decision should be left to the parents, and so the courts should not have intruded. But there remains the separate question of what would be the wisest choice for the parents (or anyone else) to make. We will focus on that question: Would it be right or wrong to separate the twins?

The Argument That We Should Save as Many as We Can. The rationale for separating the twins is that we have a choice between saving one infant or letting both die. Isn't it plainly better to save one? This argument is so appealing that many people will conclude, without further thought, that the twins should be separated. At the height of the controversy, the Ladies' Home Journal commissioned a poll to discover what Americans thought. The poll showed that 78% approved of the operation. People were obviously persuaded by the idea that we should save as many as we can. Jodie and Mary's parents, however, believed that there is an even stronger argument on the other side.

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The Argument from the Sanctity of Human Life. The parents loved both of their children, and they thought it would be wrong to kill one of them even to save the other. Of course, they were not alone in thinking this. The idea that all human life is precious, regardless of age, race, social class, or handicap, is at the core of the Western moral tradition. It is especially emphasized in religious writings. In traditional ethics, the prohibition against killing innocent humans is absolute. It does not matter if the killing would serve a good purpose; it simply cannot be done. Mary is an innocent human being, and so she may not be killed.

Is this argument sound? The judges who heard the case did not think so, for a surprising reason. They denied that the operation would kill Mary. Lord Justice Robert Walker said that the operation would merely separate Mary from her sister and then "she would die, not because she was intentionally killed, but because her own body cannot sustain her life." In other words, the operation wouldn't kill her; her body's weakness would. And so, the morality of killing is irrelevant.

The Lord Justice, however, has missed the point. It doesn't matter whether we say that Mary's death is caused by the operation or by her body's own weakness. Either way, she will be dead, and we will knowingly have hastened her death. That's the idea behind the traditional prohibition against killing the innocent.

There is, however, a more natural objection to the Argument from the Sanctity of Life. Perhaps it is not always wrong to kill innocent human beings. For example, such killings may be right when three conditions are met: (a) the innocent human has no future because she is going to die soon no matter what; (b) the innocent human has no wish to go on living, perhaps because she has no wishes at all; and (c) this killing will save others, who can go on to lead full lives. In these rare circumstances, the killing of the innocent might be justified.

1.4. Third Example: Tracy Latimer

Tracy Latimer, a 12-year-old victim of cerebral palsy, was killed by her father in 1993. Tracy lived with her family on a prairie farm in Saskatchewan, Canada. One Sunday morning while his wife and other children were at church, Robert Latimer put Tracy in the cab of his pickup truck and piped in exhaust

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fumes until she died. At the time of her death, Tracy weighed less than 40 pounds, and she was described as "functioning at the mental level of a three-month-old baby." Mrs. Latimer said that she was relieved to find Tracy dead when she arrived home and added that she "didn't have the courage" to do it herself.

Robert Latimer was tried for murder, but the judge and jury did not want to treat him harshly. The jury found him guilty of only second-degree murder and recommended that the judge ignore the mandatory 10-year sentence. The judge agreed and sentenced him to one year in prison, followed by a year of confinement to his farm. But the Supreme Court of Canada stepped in and ruled that the mandatory sentence must be imposed. Robert Latimer entered prison in 2001 and was paroled in 2008.

Legal questions aside, did Mr. Latimer do anything wrong? This case involves many of the issues that we saw in the other cases. One argument against Mr. Latimer is that Tracy's life was morally precious, and so he had no right to kill her. In his defense, it may be said that Tracy's condition was so catastrophic that she had no prospects of a "life" in any but a biological sense. Her existence had been reduced to pointless suffering, and so killing her was an act of mercy. Considering those arguments, it appears that Robert Latimer acted defensibly. There were, however, other points made by his critics.

The Argument from the Wrongness of Discriminating against the Handicapped. When Robert Latimer was given a lenient sentence by the trial court, many handicapped people felt insulted. The president of the Saskatoon Voice of People with Disabilities, who has multiple sclerosis, said: "Nobody has the right to decide my life is worth less than yours. That's the bottom line." Tracy was killed because she was handicapped, he said, and that is unconscionable. Handicapped people should be given the same respect and the same rights as everyone else.

What are we to make of this? Discrimination is always a serious matter, because it involves treating some people worse than others, for no good reason. Suppose, for example, that a blind person is refused a job simply because the employer doesn't like the idea of hiring someone who can't see. This is no better than refusing to hire someone because she is Hispanic or Jewish or female. Why is this person being treated

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